Kenneth Wayne Edmisson Jr., ND EDD RNC FNP CRNA

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

6429 Issued in TN

Practice address

225 Medical Center Dr
#405
Paducah, KY 42003-7914

Phone

(270) 441-4750

NPI assigned

Jun 26, 2005

Last updated

Oct 4, 2011By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 6

Addresses

Medicare fee-for-service enrollment

Enrolled in TN

Enrollment records 1

Specialty

Certified Registered Nurse Anesthetist (Crna)

Education

Other, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Anesthesia Medical Group, P.C.Group PAC ID 6901702307, 439 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Tristar Horizon Medical Center Hospital, Dickson, TN, CCN 440046

Merit-based Incentive Payment System (MIPS)

Final score

65.57 of 100Reported as group

Quality

59.49

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Registered Nurse

State licenses

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Anesthesia Medical Group, PC

  • Anesthesiology Physician
  • Nashville, TN
  • NPI 1215932413
  Medicare reassignment Care Compare group

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Central Tennessee Hospital Corporation

  dba Tristar Horizon Medical Center

  • General Acute Care Hospital
  • Dickson, TN
  • NPI 1871530832
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1119744000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1317686400000",
    "number": "1295731081",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "225 MEDICAL CENTER DR",
            "address_2": "#405",
            "city": "PADUCAH",
            "state": "KY",
            "postal_code": "420037914",
            "telephone_number": "270-441-4750"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "225 MEDICAL CENTER DR",
            "address_2": "#405",
            "city": "PADUCAH",
            "state": "KY",
            "postal_code": "420037914",
            "telephone_number": "270-441-4750"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EDMISSON",
        "first_name": "KENNETH",
        "middle_name": "WAYNE",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "ND EDD RNC FNP CRNA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-06-26",
        "last_updated": "2011-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TN",
            "license": "APN0000006429",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "VA",
            "license": "0024162111",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "KY",
            "license": "3007055",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "TN",
            "license": "6429",
            "primary": true
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "TX",
            "license": "1659",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "OH",
            "license": "12386-NA",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Easter Seals West Kentucky
• Easter Seals West Kentucky
• Easter Seals West Kentucky, Inc.
• Easycare Inc (Corner Homecare)
• Kelli Edging
• Paige Chanel Edmonds, PHARMD
• Brittany Edwards-King, DNP, CRNA
• Chelsea B Edwards
• Lamia Lynn Edwards, M ED., CCC-SLP
• Rhonda Edwards, MS,OTR/L

• Certified Registered Nurse Anesthetist in Paducah, KY
• Providers in Paducah, KY by specialty
• Certified Registered Nurse Anesthetist in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.